NPI Information
- NPI:
1750799482
- Provider Name:
COREY WENCL, LAT
- Classification:
Specialist/Technologist - 2255A2300X
- Specialization: Athletic Trainer
- Entity Type:
Individual
- Address:
421 CAMELOT DR
FOND DU LAC, WI
ZIP 54935
- Phone:
(920) 926-8061
Get Directions
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 2255A2300X | Specialist/Technologist | Athletic Trainer | 819-39 | WISCONSIN | Yes |